Dextrose (D50W, D10W, D5W)

Hypoglycemia rescue - 25 g IV (50 mL of D50W) corrects adult hypoglycemia rapidly; recheck glucose in 15 min and follow with a complex carbohydrate to prevent rebound.

Insulin-induced hypoglycemia in OR/intensive care unit (ICU) - D10W infusion (50–100 mL/hr) gives smoother correction than repeated D50 boluses and avoids large osmolar swings.

Hyperkalemia - 10 units regular insulin IV plus 25 g dextrose (50 mL D50W or 250 mL D10W) shifts potassium intracellularly; effect within 15–30 min and lasts about 4 hr; combine with definitive potassium-removing therapy.

Avoid hyperglycemia in neuro-injured patients - Stroke, TBI, and post-cardiac arrest patients have worse outcomes with elevated glucose; target 140–180 mg/dL.

Pediatric and neonatal hypoglycemia - Use D10W (2–5 mL/kg) for infants; D25W in children; D50W is too hyperosmolar for peripheral pediatric IVs and risks intraventricular hemorrhage in neonates.

Always give thiamine first in malnourished or alcoholic patients - Glucose without thiamine can precipitate Wernicke encephalopathy; give 100 mg IV thiamine before or with the dextrose load.

Management of excessive effect - Hyperglycemia: correct underlying cause and consider IV insulin; hypoglycemia after bolus: redose dextrose and start D10 maintenance; treat hypokalemia and hypophosphatemia.

Drug Interactions - Increases insulin requirement; precipitates with phenytoin and causes hemolysis when mixed with packed red blood cells through the same line.

Pediatric Implications - Neonates: D10W 2 mL/kg; older infants/children: D25W 0.5–1 g/kg or D10W 5–10 mL/kg. Avoid D50W peripherally because of hyperosmolar injury.

Obstetric Implications - Maternal hyperglycemia produces fetal hyperinsulinemia and predisposes the neonate to hypoglycemia after delivery; avoid routine dextrose-containing fluids in late labor unless treating documented maternal hypoglycemia.

Absolute: hyperosmolar hyperglycemic state (HHS), severe hyperglycemia, intracranial hemorrhage with active hyperglycemia.

Relative: anuria, hypertonic dehydration, post-cardiac arrest, traumatic brain injury, stroke (avoid hyperglycemia), neonatal use of D50 (osmolar load).

Caution: malnourished or alcoholic patient (give thiamine first), critically ill with stress hyperglycemia, peripheral IV with concentrations above D10.

Adult hypoglycemia: 25 g IV (50 mL of D50W); may repeat once and start a D10W infusion.

Hyperkalemia: 25 g IV (50 mL D50W or 250 mL D10W) with 10 units regular insulin IV.

Pediatric hypoglycemia: D25W 2–4 mL/kg or D10W 5–10 mL/kg.

Neonatal hypoglycemia: D10W 2 mL/kg over 1–2 min.

D5W or D10W at 50–100 mL/hr for ongoing glucose support; titrate to a target glucose of 140–180 mg/dL in critical illness.

Direct glucose substrate for cellular metabolism; raises serum glucose, stimulates endogenous insulin release, drives potassium and phosphate intracellularly.

Cellular; converted to ATP, CO2, and water through glycolysis and oxidative phosphorylation.

None at normal serum glucose; renal spillover above ~180 mg/dL.

D50W: 50% dextrose, 0.5 g/mL, 25 g per 50 mL amp, ~2525 mOsm/L. Extremely hypertonic; central line preferred for repeated dosing, although large peripheral access is acceptable in emergencies.

D10W: 10% dextrose, 100 mg/mL, ~506 mOsm/L; safe via peripheral IV.

D5W: isotonic with serum at 50 mg/mL.

Vesicant on extravasation. Apply warm compresses and elevate; do not use cold compresses.

Always pair with thiamine 100 mg IV in alcoholic or malnourished patients to prevent Wernicke encephalopathy.

Incompatible with phenytoin (precipitates) and packed red blood cells (causes hemolysis when co-infused).